| Condition |
T |
B |
F |
VP |
| Skip lines while reading or copying |
X |
X |
|
|
| Lose your place while reading or copying |
X |
X |
|
|
| Reverse letters, numbers or words |
|
|
|
X |
| Poor reading comprehension, difficulty remembering what you’ve read |
X |
X |
X |
X |
| Headaches after intense visual activities such as reading or computer work |
X |
X |
X |
|
| Unusually tired after completing a visual task |
X |
X |
X |
|
| Misalign letters or numbers |
|
|
|
X |
| Poor word recall & recognition |
|
|
|
X |
| Does not know math facts automatically |
|
|
|
X |
| Difficulty following instructions (written or verbal) |
|
|
|
X |
| Avoid near tasks such as reading |
X |
X |
X |
|
| You must feel things to “see” them |
|
|
|
X |
| Excessive blinking |
X |
X |
X |
|
| Sensitivity to light |
X |
X |
X |
|
| Red eyes |
X |
X |
X |
|
| Totals |
20 |
20 |
14 |
20 |
| Maximum Possible |
69 |
84 |
54 |
55 |
